I am aware of that. It can catch near 99$ of all PEs and probably 100% of all massive PEs. I had a positive d-dimer and all that was done was a v/q scan. PEs are also very elusive and some say kill over 200,000 people ever year, it should be high on the list whenever anyone comes to the ER with chest pain and pain when breathing.
We rarely get VQ scans these days because too many are “inderminate”. You get three choices “high probability”, “low probability” and “inderminate”. Notice low probability does not mean negative. The CT is much more sensitive and specific at detecting PE.
PE is a huge problem in the ER. Yes the ddimer helps IN THE RIGHT PATIENT POPULATION”. The proper way to approach the diagnosis is a careful history, a physical exam, looking at the vitals and selective testing. If you shotgun the ddimer you end up doing a lot of unnecessary CT’s and VQ scans.
“The diagnostic yield of D-dimer relies on its specificity, which
varies according to patient characteristics. The specificity of
D-dimer in suspected PE decreases steadily with age and may
reach
10% in patients above 80 years.
81
D-dimer is also more
frequently elevated in patients with cancer,
82,83
in hospitalized
patients
84
and during pregnancy.
85,86
Therefore, the number of
patients with suspected PE in whom D-dimer must be measured
to exclude one PE (also referred to as the number needed to
test) varies between 3 in the emergency department and 10 or
above in the specific situations listed above. Deciding whether
measuring D-dimer is worthwhile in a given situation remains a
matter of clinical judgement.”
ESC GUIDELINES
Guidelines on the diagnosis and management
of acute pulmonary embolism
The Task Force for the Diagnosis and Management of Acute
Pulmonary Embolism of the European Society of Cardiology (ESC